Office Workspace Ergonomic Self-Evaluation Form

• Legal Form Number: Ergonomics
• Section: Office of Congressional Workplace Rights (United States)

Contact OCWR at OSH@ocwr.gov if you have any questions or would like additional information.

Oice

Workspace

Ergonomic

Self-Evaluation

The Oice of Congressional Workplace Rights is

committed to minimizing musculoskeletal disorders

(MSD) throughout the legislative branch. Some

employing oices may already have ergonomic

programs, and this guidance is not intended to replace

those programs, but it may oer supplemental

information. Work through this self-evaluation to

determine if adjustments or changes can be made to your

workspace to mitigate any hazards associated with MSD.

Name

Organization

Room Number

Phone Number

Date

Building

Email

Workstation Position

1

1

2

3

5

4

1

4

1